New Publication on Empathic Conjectures in Journal of Marital & Family Therapy

 Just published online in open access: A new study, "Empathic Conjectures in Emotionally Focused Couple Therapy (EFCT): A Process Microanalytic Study," by Hamed Fatahian-Tehran, Simran Chatha & me.  In the Journal of Marital & Family Therapy. 

This was a fun project, initiated when Hamed and Simran each separately approached me about doing a research project on EFT. What transpired was an analysis of 12 sessions of Emotionally-Focused Couples Therapy available for training purposes. We decided to study empathic conjectures (therapist responses that guess about previously unspoken client experiences), focusing on characteristics that define empathic conjectures and identifying different types of empathic conjectures. This basically a new type of therapy process research, which we decided to call "Process Microanalysis." I'm hoping that others will take up this approach, replicating and extending our results and applying it to other types of EFT therapist response.

 Fatahian-Tehran, H.M., Chatha, S. and Elliott, R. (2025), Empathic Conjectures in Emotionally Focused Couple Therapy (EFCT): A Process Microanalytic Study. Journal of Marital and Family Therapy, 51: e70075. https://doi.org/10.1111/jmft.70075

 

Person-Centered/Experiential Psychotherapy for Anxiety Difficulties: Theory, Research and Practice

Entry for 17 May 2013:

Last July, about a week after my return from California after the two months I spent helping care for my mother, I gave my first keynote presentation to a conference of the World Association for Person-Centered and Experiential Psychotherapies.  The talk, given in Antwerp, Belgium, was the basis for an article just published in Person-Centered and Experiential Psychotherapies.  It combines selected results from two studies: the 2008 humanistic-experiential psychotherapy outcome meta-analysis that Beth  Freire and I carried out with support from British Association for the Person-Centre Approach; and the First Strathclyde Social Anxiety Project, largely funded by grants from the New Professors Fund by the University of Strathclyde and by Counselling Unit internal funds. 

I am deeply appreciative of the help I received in carrying out the research on which this article is based, including the clients, volunteer therapists, students, research associates, and members of the Social Anxiety Study Group, University of Strathclyde, 2006-2012, especially my colleagues Brian Rodgers, Beth Freire, Susan Stephen, Lorna Carrick, Lucia Berdondini, and Mick Cooper.   In addition, Les Greenberg and Ann Weiser Cornell made helpful contributions to the theory sections of this article.  Finally, I have dedicated this article to the memory of my mother, Ann Helena Kearney Elliott, 7 April 1929 – 22 June 2012.

Although the article has been available on the publisher’s website since March, it was very nice to receive the hard copy of it the other day.

Reference:

Elliott, R. (2013). Person-Centered-Experiential Psychotherapy for Anxiety Difficulties: Theory, Research and Practice.  Person-Centered and Experiential Psychotherapies, 12, 14-30. DOI:10.1080/14779757.2013.767750

Abstract: Anxiety difficulties are an increasingly important focus for person-centered-experiential (PCE) psychotherapies.  I begin by reviewing person-centered, focusing-oriented, and emotion-focused therapy (EFT) theories of anxiety.  Next, I summarize a meta-analysis of 19 outcome studies of PCE therapies for adults with anxiety, most commonly supportive or person-centered therapies (PCT) carried out by cognitive behavior therapy (CBT) researchers.  The results indicate large pre-post change but a clear inferiority to CBT.  I then summarize promising early results from an ongoing study of PCT and EFT for social anxiety, which show large amounts of pre-post change for both forms of PCE therapy but substantially more change for clients in the EFT condition.  I conclude with a discussion of the implications for PCE therapy practice, including the value of process differentiation and the possibility of developing more effective PCE approaches for anxiety.

Stephen & Elliott (2011), “Developing the Adjudicated Case Study“

Entry for 3 March 2011:

Commentary on a Commentary: For the past several years Dan Fishman, editor of Pragmatic Case Studies in Psychotherapy, has been trying to get me to submit one of our HSCED studies to his online journal. For various reasons, we’ve been unable to accommodate him. However, last Fall he made me an offer I couldn’t refuse: the opportunity to write a commentary on two adjudicated case study projects, one from Ron Miller and his team, and the other from Art Bohart and colleagues. I asked Susan Stephen, one of my PhD students to work with me on this, because she has a special interest in the topic and is doing her PhD research on the HSCED method.

When the package of 10 articles arrived at the end of this past December, however, we realized that we’d gotten a bit more than we’d bargained for. There was a lot of material get through! However, we dived into the papers and were able to work our way through them. In the process, Susan got considerably ahead of me and ended up writing the bulk of the paper, so I was very pleased for her to be first author. Actually, I thought she did a great job, although I was able to earn my keep by adding several sections and contributing bits here and there, especially on the history. In the process I think we produced a very useful paper discussing issues about the implementation of adjudicated case study methods that we hadn’t seen discussed before. This paper, along with the rest of this issue of PCSP, now becomes required reading for everyone involved in HSCED and other adjudicated case study methods, or even just contemplating using this method.

Abstract: In this commentary we discuss Miller’s Panel of Psychological Inquiry (PPI) and Bohart’s Research Jury method approaches to the development of the adjudicated case study method, as represented by the papers assembled for this issue of Pragmatic Case Studies in Psychotherapy. In our view, the case studies presented here demonstrate the rapidly developing potential offered by this approach for psychotherapy research and reveal many parallels to recent research using the Hermeneutic Single Case Efficacy Design (HSCED) model. In our view, each of the three models has taken significant steps forward in adapting particular aspects of the legal process as viable psychotherapy research procedures. In this commentary we summarize the HSCED method, then take readers through the issues of the sources of the evidence used; ways in which that evidence is tested; claims, burden and standard of proof; and the handling of the adjudication process itself. We conclude with recommendations for further development of adjudicated case study methods.

Reference: Stephen, S., & Elliott, R. (2011). Developing the Adjudicated Case Study Method. Pragmatic Case Studies in Psychotherapy, 7(1), 230-241. Available online at: http://pcsp.libraries.rutgers.edu.

Empirically Supported Relationships Summaries Published Online

Entry for 13 November 2010:

Last year, Art Bohart, Jeanne Watson, Les Greenberg & I were asked to update our 2002 meta-analysis of research on the relationship between therapist empathy and therapy outcome, published in John Norcross’s Psychotherapy Relationships That Work. The revised version, in book chapter and journal article formats is still in press; however, a sneak preview version has just been published online, along with the rest of the reviews to appear on the second edition of John’s book.

SAMHSA, the Substance Abuse and Mental Health Services Administration, is a branch of the US government responsible for improving treatment of mental health and substance abuse issues by funding research and disseminating information about evidence-based practice. Somehow, the Powers That Be were persuaded to sanction summaries of the current set of meta-analytic reviews being published on their website.

SAMHSA have now published online a set of summaries of evidence supporting the importance of different aspects of the therapeutic relationship for promoting successful psychotherapy or counselling. We updated and replicated our previous analyses with somewhat larger data set and found a moderately strong and highly reliable relationship between therapist empathy and therapy outcome. In addition to empathy, the other Rogerian conditions of therapist warmth and genuineness also fare quite well.

The summary of our review can be found at: http://www.nrepp.samhsa.gov/Norcross.aspx#chapter6

The other reviews can be found in other parts of the same document/webpage.

Reference:

Elliott, R., Bohart, A.C., Watson, J.C., & Greenberg, L.S. (2010). Empathy. In J. C. Norcross (ed.), Evidence-Based Therapy Relationships. National Registry of Evidence-based Programs and Practices (NREPP). Online Resource, available at: http://174.140.153.165/Norcross.aspx#chapter6

Elliott (2010). Psychotherapy Change Process Research: Realizing the Promise

Entry for 31 March 2010:

When I received the Distinguished Research Career Award from the Society for Psychotherapy Research in June 2008, it came with a catch: I had to produce a paper for SPR’s journal, Psychotherapy Research. Paulo Machado asked me in Barcelona shortly after I got the award, giving me what felt at the time like a generous deadline: Aug 1, 2009. I spent months wondering what I should write about; I even sounded Paulo and Clara out about using my long-neglected Adjudicated HSCED paper (Elliott et al., 2009) for this purpose, but was gently reminded that it had to be single-authored.

Somewhere around February or March 2009 I finally realized that the only logical thing was for me to write about Change Process Research (CPR), a topic close to my heart and one that has spanned my research career. By a strange piece of synchronicity, Madison, Wisconsin, provided a 30-year time loop encircling my interest in CPR: At the front end of the time loop, my scientific interest in CPR dates back to a fateful conversation that I had with Les Greenberg in 1977, as we drove to O’Hare Airport after that year’s SPR meeting in Madison, Wisconsin. At the other end of the time loop, I had given a plenary paper on CPR at the 2007 SPR meeting, which was once again in Madison. The Madison 2007 paper became the starting point for my senior career award paper.

Because my writing schedule is generally restricted these days to 20 minutes each morning, work on the paper proceed slowly, as the pressure from Paulo increased to produce the paper, as it turned out, earlier than the original deadline. April and May passed, with the paper being repeatedly pushed aside for other pressing writing projects, including final work on the adjudicated HSCED paper. I had promised Paulo something by the end of June; however, I arrived in Santiago de Chile in late June with only a fraction of the paper drafted.

Then I came down with the H1N1 or Swine Flu, which was pretty awful in itself, but turned out to be gift from heaven as far as my senior career CPR paper was concerned. First, I was quarantined in my hotel room for a week, so I had plenty of time to lay in bed with minimal distractions. Second, the doctor had given a timely dose of Tamiflu, which reduced the flu symptoms enough so that I actually had enough energy to work on the paper. As a result, I wrote most of the paper during the week after the Santiago SPR meeting.

The paper turned out to be a tour de force, a survey of the major approaches to CPR, featuring lots of references and examples. It felt big, and was an odd contrast to my situation at the time, living in the enforced role of an invalid while putting together a grand survey of the key approaches at the core of the most central focus of the psychotherapy research field. Nevertheless, thanks to the H1N1 virus, Tamiflu, and especially to Diane’s patient help, the paper got written and was submitted on the 3^rd of July.

See also January 18, 2010 entry on this blog for a previous excerpt from this article: Change Process Research on Relational Depth: The Added Paragraph

Reference:

Elliott, R. (2010). Psychotherapy Change Process Research: Realizing the Promise. Psychotherapy Research, 20, 123-135.

Abstract: Change process research (CPR) is the study of the processes by which change occurs in psychotherapy, and is a necessary complement to randomized clinical trials and other forms of efficacy research. In this article I describe and evaluate of four types of CPR. The first three are basic designs and include quantitative Process-Outcome, qualitative Helpful Factors, and micro-analytic Sequential Process; the fourth, the Significant Events approach, refers to methods such as Task Analysis and Comprehensive Process Analysis that integrate the first three. The strengths and weaknesses of each design are described and summarized using both causal and practical criteria, as part of an overall argument for systematic methodological pluralism.

Change Process Research on Relational Depth: The Added Paragraph

Entry for 18 January 2010:

Sometimes, an editor or reviewer will call for a last-minute revision that turns out to be a kind of gift, because it takes the paper to another level. In my forthcoming paper on Change Process Research, to appear in the next month or two in Psychotherapy Research, one of the reviewers challenged me to add an example of how the framework of types of change process research I’d been presenting might inspire research. When I asked myself what kind of therapy process might provide a good example, I suddenly thought of Relational Depth, which is a sort of University of Strathclyde speciality. The following paragraph came quickly after that, as I outlined a program of research on this therapy process variable:

Instead [of an RCT on Relational Depth], any one of the designs reviewed here provides a sounder basis for inferring the operation of particular therapy processes in bringing about client change. The optimal strategy, however, is to use several different Change Process Research designs, within or across studies, to build a convincing case for a particular change process. Take for example relational depth (Mearns & Cooper, 2005), a newly-minted formulation for a powerful state of felt connectedness between client and therapist. In order to make a strong case for the causal efficacy of this change process, researchers might want to start with Helpful Factors studies, in order to document the existence and general nature of moments of relational depth (e.g., Knox, 2008). Next, Significant Events studies, using Comprehensive Process Analysis or Task Analysis, could be used to develop and refine models of how client and therapist behaviors and experiences unfold and interact during episodes of relational depth. These models could be further tested at a micro-process level using the Sequential Analysis approach. Finally, quantitative measures (e.g., Wiggins, 2009) could be developed and used in Process-Outcome studies to predict therapy outcome. A body of such complementary studies would go a long way toward establishing the causal efficacy of relational depth in bringing about change in therapy, something that would be difficult if not impossible to do using randomized clinical trials.

References:

Knox, R. (2008) Clients’ experiences of relational depth in person-centred counselling. Counselling and Psychotherapy Research, 8:3, 182-188.

Mearns, D. & Cooper, M. (2005). Working at Relational Depth in Counselling and Psychotherapy. London: Sage.

Wiggins, S. (March, 2009). Developing the Relational Depth Inventory: Prevalence, Moderators & Characteristics of Relational Depth Events. Paper presented at Meeting of the UK Chapter of the Society for Psychotherapy Research, Ravenscar, UK.

aHSCED study finally published: Elliott et al. (2009)

Entry for 4 October 2009:

Reference: Elliott, R., Partyka, R., Wagner, J., Alperin, R. & Dobrenski. R., Messer, S.B., Watson, J.C. & Castonguay, L.G. (2009). An Adjudicated Hermeneutic Single-Case Efficacy Design of Experiential Therapy for Panic/Phobia. Psychotherapy Research, 19, 543-557. [Appendices available at: http://www.informaworld.com/smpp/content~content=a914761426~db=all~tab=multimedia]

Commentary: In developing the Hermeneutic Single Case Efficacy Design (HSCED) method, my students and I at Toledo experimented with various research strategies. The first published HSCED study (Elliott, 2004) was my SPR Presidential Address paper, and was based on the idea that the method could be carried out by single therapists with their own clients. This model of HSCED research still makes some sense to me, but is regarded with suspicion in the Person-centred community in the UK, because of the dual relationship issues. (Incidentally, this is an argument that has never held much water for me, because of the long history of narrative case studies, the great prepounderance of which were therapists written about their own clients. This particular squeamishness seems to come out of general distrust and alienation between research and practice.)

In any case, my team at Toledo also experimented early on with doing case comparisons (which we presented at the 1999 SPR conference in Chicago): These proved unwieldy and were replaced by single-case case studies. Next, inspired by Art Bohart and Carol Humphreys, we began experimenting with a legalistic or adjudicated case study model, built around the HSCED framework of types of evidence and alternative explanations or validity threats. The first of these cases was planned in 2000, even before I gave SPR Presidential Address at the SPR conference in Montevideo, Uruguay. A client came to the Center for the Study of Experiential Psychotherapy (CSEP) suffering from severe anxiety difficulties with panic episodes associated with crossing bridges and heights. He was an older gentleman, had had an earlier unsuccessful CBT treatment for these problems, and looked to the research team to be a challenging case. At the same time, I’d been doing meta-analytic research that pointed to the possibility that person-centred-experiential (PCE)) therapy might be less effective with anxiety problems.

As a result, we assigned this client, whom we eventually renamed as “George”, to me. Although I’d worked with PTSD quite a bit, I hadn’t worked with panic difficulties very much, so I did some reading on experiential approaches to panic difficulties and got a bit of consultation from Barry Wolfe, who done some work on the topic and whom I ran into at a meeting. Rhea Partyka coordinated the study and was the researcher who interviewed George.

I began seeing George, with a fair amount of trepidation: Could George and I find a way of working together that would enable him to overcome his severe anxiety difficulties in a time-limited (up to 40 sessions) therapy? Or had I bitten off more than I could chew?

Fortunately, George and I hit it off really well, worked hard, and after 23 sessions, George, with no pressure from me, felt satisfied with his progress enough to declare himself finished with therapy. At this point, the research team began organizing the adjudication process: We lined up three judges from well-known psychotherapy researchers, each representing a different theoretical orientation: Stan Messer (psychodynamic), Jeanne Watson (humanistic), and Louis Castonguay (cognitive-behavioral). We assembled two teams of two postgrad clinical psychology students each, an affirmative team (Rhea Partyka and Becky Alperin) to argue the case in favor of George having changed and for therapy having been responsible for George’s having changed; and a sceptic team (John Wagner and Rob Dobrenski) to argue the opposite. Rhea and I put together a set of documents summarizing the process and outcome of the therapy and agreed to by affirmative and sceptic teams. Then affirmative sceptic teams each wrote briefs and offered rebuttals to each other’s cases. All of this was sent off to our three judges, who each had instructions to render verdicts on the two questions of client change and the contribution of therapy to possible client change.

What did the judges rule? See the Abstract below, or better yet go look up the article and the Appendix that contains all the case documents, including the judges’ commentaries.

All this sounds fairly straightforward; however, it proved to be challenging to write up this study for publication and to deal with the editorial feedback. First, it took me two years to get it written up and submitted. Our original idea was that it would be published as a suite of three papers: (a) Paper describing the case method and summarizing the Rich Case Record and Affirmative and Sceptic Briefs and Rebuttals (U of Toledo team as co-authors); (b) judging procedure and judges’ opinions (judges as authors); and (c) follow-up data, and general discussion (Elliott & Partyka as co-authors). I submitted this unusual package to Psychotherapy Research, under Bill Stiles’ editorship; Bill gave us a revise and resubmit verdict asking us to combine all this into a single paper. And there the paper sat for 5 years, aside from a couple of false starts, until a year ago, when I began my 20-minute a day writing regime. This was what finally enabled me to gain momentum on the revision, so that when 4 days for writing suddenly opened up in early January of this year, I was able to finish the revisions and resubmit. My co-authors were delighted to see the thing moving again after the long delay, and even more so to see it finally appear in print.

One of the technical challenges of publishing HSCED studies is what to do with the extensive documentation, in this Rich Case Record, Briefs, Rebuttals, and Judges’ Opinions. In this case, that puzzled has been dealt with by publishing these materials online, on the journal’s website.

Abstract

This paper illustrates the application of an adjudicated form of Hermeneutic Single Case Efficacy Design (HSCED), a critical-reflective method for inferring change and therapeutic influence in single therapy cases. The client was a 61 year-old European-American male diagnosed with panic and bridge phobia. He was seen for 23 sessions of individual Process-Experiential/Emotion-Focused Therapy. In this study, affirmative and skeptic teams of researchers developed opposing arguments regarding whether the client changed over therapy and whether therapy was responsible for these changes. Three judges representing different theoretical orientations then assessed data and arguments, rendering judgments in favor of the affirmative side. We discuss clinical implications and recommendations for the future interpretive case study research.

Stincken, Elliott & Leijssen (2009) Published

Entry for 25 August 2009:

Five years ago, I was having a really hard time at my previous job, and as a way of getting some space from departmental politics, was offered the opportunity to work for 8 weeks a year for two years as a guest professor at the Katholieke Universiteit Leuven (KUL), in Belgium. My old friend Germain Lietaer was retiring and they needed someone to teach a course on psychotherapy, help supervise a couple of their PhD students, and help strengthen the research component of their parttime Person-Centred-Experiential (PCE) therapy postgraduate course. We arranged that I would come 4 times a year for two weeks at a time, and that I would teach the course partly as a distance learning course. There then followed a rather crazy schedule in which on top of my teaching at the University of Toledo, I kept sloping off to Belgium where I had this other life.

Among other things, I started studying Dutch. For one of the visits, Diane and Kenneth came along, and we all did a privately-tutored two-week intensive course in Dutch, during which we would have long arguments about grammar and syntax and theories of language learning. I guess you could think of it as a peculiar form of Extreme Family Vacation.

One of things I worked on over those two years was the development of a protocol for an empirical single case study requirement in the PCE therapy course. Nele Stinckens was (and is) the director of the course and we began working together on this project. Nele is very organized, bright Flemish psychologist with a puckish sense of humor and a strong sense of herself. She asked one of her clients to be a demonstration case study and provided a professional example of what we were asking the students to do. I did a presentation on one of my case studies (the client with the bridge phobia; the write-up has also just been published). We worked with the students to help keep them moving and to help them deal with their stuck places, of which there were many. We presented our ongoing work at several conferences, and eventually wrote it up. This is the article that emerged out of that collaboration and my two years at KUL. It is a real pleasure to see it appear in print.

Abstract: The goal of the Leuven systematic case-study research protocol project is to stimulate practice-oriented research in order to bridge the gap between research and practice. In this article we give a progress report of the project, in which a set of Dutch-language research instruments was created and tested with postgraduate trainees in Person-Centred/Experiential therapy at the University in Leuven (Belgium). We begin by presenting the general framework for the protocol, including the three major domains of therapy process, therapy outcome and client/therapist characteristics. Then, we give an overview of the quantitative and qualitative instruments used. We explain how the project has been implemented in the postgraduate programme. To evaluate the success of the project, we analyzed the answers of our trainees on a questionnaire. We give an overview of the clinical cases involved and the variety of research questions that have been formulated in the individual case-studies. Finally we discuss the value of this pilot project.

Reference: Stinckens, N., Elliott, R., & Leijssen, M. (2009). Bridging the Gap Between Therapy Research and Practice in a Person-Centered/Experiential Therapy Training Program: The Leuven Systematic Case-study Research Protocol. Person-Centred and Experiential Psychotherapies, 8, 143-162.

Freedom on the 4th of July

Entry for 4 July 2009:

It’s been a long week of sitting around my hotel room waiting for my 7-day quarantine to run out. The Tamiflu did away with most of the flu that I’d been so miserable with when I first came down with it. After the first day on it, all I had left was a bit of a cough. As the days passed, we developed a routine: We’d get up about 8am, after 8 hours of sleep. Diane would go down for breakfast, and bring me back a bowl with a bit of fruit at the bottom, to which I’d add granola and yoghurt. After breakfast, I’d do email for a couple of hours, trying to staunch for great gouts of messages that assailed me once I started answering people. (In spite of having a lot of time to do email, I barely managed to hold my own for the week, still a bit over 1000 messages in my inbox.) Then, we’d have lunch, cobbled to together with bits from breakfast and that Diane picked up at the grocery store. After that, I’d write for 4 or 5 hours, with a nap somewhere in the middle, until about 8pm, when we’d stop for dinner. Finally, we’d watch In Treatment on Spanish-language HBO, the hit psychotherapy drama that the US graduate students at the SPR conference were raving about as their main source of information about what really goes on in therapy. (A rather troubling thought, but that’s the subject for another blog…)

As I said, after lunch each day, I’d work on my Distinguished Career Award paper for Psychotherapy Research, now a month overdue. Paulo Machado has been nagging me about it for a year, since I got the award in Barcelona, and once against reminded me about how much he needed it when I saw him last week at the conference. I’d spent months trying to figure out what to do it on. It felts like I had to write something important, summing up the accumulated wisdom of decades of doing psychotherapy research. A tall order!, especially when I don’t feel particularly wise… Finally, I hit upon “Psychotherapy Change Process Research” as a suitable topic. Building off my 2007 paper for the German-language Person-Centred journal, Person, six weeks of 15 min per day plus several hours on the plane coming to Chile got me about 2/3 of the way through the paper. It’s not clear how many more weeks it would have taken if I hadn’t come done with the flu, but a week’s enforced bed-rest was enough to buy me the time to finish the paper, which I finally submitted last night. It was a challenging paper to write, an appraisal of what I see as the main methodological approaches to studying what makes therapy work, really a methodological tour de force. I spent a day at the end just filling in and checking my references. I hope that it will inspire others to use a broader range of methods more effectively.

I decided that I would count today, the 4th of July, as the end of my 7-day quarantine and proposed that we go out to dinner to celebrate. I spent the afternoon checking the proofs for the Adjudicated HSCED paper, which I’d finally manage to get revised last January. Then, a bit after 8pm tonight, I put on my shoes and jacket for the first time since last Sunday, and went down stairs. It felt strange to be outside of my room.

I’d passed a Mexican restaurant on Avenida Manuel Montt, around the corner from Gloria’s flat, so I dragged Diane there. Mexican food is what I miss most in Scotland. They’d toned the spiciness way down for Chilean tastes, but it was close enough to remind me of home, and we celebrated freedom, both personal and national. As Diane noted, it was much nicer than having to worry about the neighbors burning the place down with illegal fireworks. A man and a woman were playing Mariachi music, also toned down for Chilean tastes but still colourful and entertaining. I miss the US, I miss Scotland, I miss my Northern hemisphere summer, but it felt very good to finally get out for a few hours, to resume what will have to do for a normal life until we can get back to Scotland.

Narrative and External Validity in Hermeneutic Single Case Efficacy Design

Entry for 12 March 2009:

Note. The good news was that this week, after many years’ delay, the paper on the adjudicated version of the HSCED method was finally accepted for Psychotherapy Research by Clara Hill. The bad news was that she made us cut another 10+ pages from it, including the abridged version of the judges’ opinions that we’d sweated over last January and a cool bit of the Discussion that she didn’t think fit that well with the rest. She’s probably right about it not fitting that well, but I think it’s nice enough and of general interest enough to post here as a blog entry, because it’s where I really develop the idea of a narrative approach to HSCED. And because it’s about the method in general rather than about the particular case, it makes sense out of context. So here is another outtake from “An Adjudicated Hermeneutic Single Case Efficacy Design Study of Experiential Therapy for Panic/Phobia”:


In the course of carrying out this study, we (and our audiences) struggled with the large amount of often-contradictory information generated by the HSCED method. As a result, we began to develop a more narrative view of HSCED. It now seems to us that making causal inferences in general is fundamentally a narrative process. That is, explaining something that has happened, such as the outcome of a client’s therapy, involves constructing a story about how and why it came about. HSCED is therefore a narrative research method. As we now see it, the function of the Affirmative and Skeptic teams is to create persuasive narratives that express a particular view of the data. In addition, the judges each construct their own narratives as they seek to make sense of the case from their own theoretical perspective. These competing narratives are part of a dialectic process that serves to clarify our understanding of whether and how the client changed and what brought any changes about. The goal is not necessarily to construct a single master narrative to bind together all the other narratives, but rather to highlight the main plausible, coherent accounts and the remaining ambiguities. Systematic data collection, argumentation and judging processes offer reasonable methods for eliminating error and estimating where the weight of the evidence falls.

Viewing HSCED as a narrative research method also helps us to think about the perennial issue of generalizing from single cases (cf. Stiles, 1994). It now seems to us that a good narrative provides two pillars for inferring generalizability: First, it supplies orienting contextual information (moderator variables) that helps us judge the relevance and applicability of the results to other, similar cases. In particular, it is important that the formulation include what we think it was that the client brought to therapy that made change possible, as we have done for George. Second, the description of the sequence of primary change processes tells us what in the therapy was relevant to change, that is, the active mediator variables. This allows us to reframe the Kiesler (1966)/Paul (1967) specificity “litany” for single case research: “When a client with these problems, those resources and this history experiences these in-therapy change processes, then this kind of change is possible/likely.” Thus, effective affirmative researcher-constructed narratives and judges’ opinions should include views about what the client brought to therapy that was relevant to his/her successful therapy. (Skeptic teams might similarly try to account for the apparent failure of the therapy.) Establishing this for a single case shows what is possible; in legal terms, it establishes a precedent. Identifying the same factors in multiple similar cases through replication increases the likelihood the same relationships will hold in future similar cases, as well as clarifying further conditions under which this is likely or unlikely to be the case (cf. Sidman, 1960).

Thus, along with Fishman (1999), Bohart and Boyd (1997), Miller (2004) and Stiles (2007), we are proposing a science of single cases, using the quasi-judicial methods illustrated here. Such single case causal studies can be done in standalone fashion as was done here, but they can (and should) also be carried out within group designs to help researchers understand their results, essentially filling in the “black box” in a randomized clinical trial. To those familiar with Sidman’s (1960) classic work in behavioral single case experimental design, this may be seen as coming full circle, but with a broader range of methods that apply to a wide range of therapy approaches.

Furthermore, what do we mean by “therapy” when we make the inference that therapy was a major influence on client change? Surely we are not referring only to the therapist’s interventions but presumably mean the partnership of both people working together. Therefore, “therapy” here refers not only to the opportunities that the therapist offers the client, but also the opportunities the client offers the therapist, and also how client and therapist make use of those opportunities within therapy. Although the driving questions used here in HSCED are phrased in terms that sound like old-fashioned linear causality, it does not take the method long to uncover multiple sets of complex bidirectional causal processes in which client and therapist offer each other opportunities to work together productively within the context of the client’s larger life, which itself continually interacts with therapy process and outcome, with both immediate and delayed effects on the client’s problems and life functioning. From the point of view of HSCED, we now believe that it is enough for therapy (and the therapist) to play an important, but by no means exclusive, role in the client’s continuing change process. Interpretive single case methods such as HSCED offer the possibility of beginning to specify such complex, nonlinear interactive processes.

References:

Bohart, A.C., & Boyd, G. (Dec., 1997). Clients' construction of the therapy process: A qualitative analysis. Poster presented at meeting of North American Chapter of the Society for Psychotherapy Research.

Fishman, D.B. (1999). The case for pragmatic psychology. New York: New York University Press.

Kiesler, D.J. (1966). Some myths of psychotherapy research and the search for a paradigm. Psychological Bulletin, 65, 110-136.

Miller, R.B. (2004). Facing Human Suffering: Psychology and Psychotherapy as Moral Engagement. Washington, DC: APA.

Paul, G.L. (1967). Strategy of outcome research in psychotherapy. Journal of Consulting Psychology, 31, 109-118.

Sidman, M. (1960). Tactics of scientific research. New York: Basic.

Stiles, W.B. (1994). What do you know once you’ve heard a story? Paper presented at meeting of Society for Psychotherapy Research, York, England.

Stiles, W. B. (2007). Theory-building case studies of counselling and psychotherapy. Counselling and Psychotherapy Research, 7, 122-127.

Minor Miracles: Summing up the Holidays

Entry for 6/9 January 2009:

These few days after our return to Toledo from California, sandwiched in between the holidays and return to Scotland and work allowed us a gentle taste of Midwestern winter. Most of the days were clear and cold but not too frigid. It’s a peaceful time of year, the holidays done, a bit a space to breathe in, and by some miracle I was able to catch up on my unread email, reducing the pile from over 800 when we left Scotland to about 60.

The larger miracle is that this has allowed me to finally get some writing done on the adjudicated HSCED (Hermeneutic Single Case Efficacy Design) manuscript, whose revision I’ve been sitting on for more than five years. The original version was ridiculously long; I’d had the delusion of being able to publish it as a series of 3 related papers, but the editor (my friend Bill Stiles) wasn’t having it and had asked me to condense it into one paper of no more than 60 pages. Speaking as a former journal editor, I think this was a good call, but presented me with a lot of work at a time when my job had become very stressful and I was doing a lot of extra work, such as teaching 8 weeks a year in Belgium. Then we moved to Scotland, and thing got more complicated. Now, however, my students in Scotland are starting to produce their own HSCED studies and John McLeod and I are in the middle of a run of conferences on systematic case study design, so the pressure is on to get this key paper done.

I’d been progressing it slowly, using my 15 min/day regime, but this was taking a long time. Finally, this past Monday, I emerged into the clearing left by having gotten my email under control for the first time in a year. I started working on the aHSCED paper for 3 – 4 hrs/day. A paper like this is filled with complex details that are tricky to handle and describe, and I was faced with 10 pages of editorial feedback to deal with, always a daunting prospect. There is a real art to writing a scientific paper with maximum clarity, balancing one’s interests, the reviewer’s suggestions, and what the data are saying. To do it well is really a labor of love, and I believe that it shows in the final product. It needed big blocks of time to finish these revisions, but I made steady progress, and finally, yesterday (Thursday) I sent it off to my seven co-authors for their suggestions and approval. Whew! We all went out to Kotobuki, our favorite Toledo-area Japanese restaurant, to celebrate belated November and December birthdays. Mission accomplished! There will probably be two more revisions after this, but they are unlikely to be as extensive or as time-consuming.

Now we’re taking Kenneth back to school in Cleveland, facing a major winter storm that is advancing through the area and which may interfere with our flight back to Scotland tomorrow afternoon. Our peaceful winterlude is ending, but it’s been a time of clearing things out (not just email; most of us has a short, sharp stomach bug over Christmas). Also for getting caught up on sleep, for kicking back a bit, for reading graphic novels (volume 5 of Fables and volume 3 of the League of Extraordinary Gentlemen) and science fiction (Stross’ Saturn’s Children), for getting back into running (3-4 times a week, including a 7.5 mile run around the Pleasanton ring road on New Years Day with Kenneth), and for finally healing from the exhaustion and lingering effects of last Fall.

Kenneth’s pleased to see his friends, and as we sit around Aladdin’s in Cleveland Heights, eating our smoothies and wraps, they all chatter about what they did over winter break and about Pokemon, which they all seem to have been playing lately, out of some kind of nostalgia. We leave them to do their grocery shopping, and head back into the early January just-before-the-snow-storm-Friday-night-rush-hour-traffic. We hide it, but we’re a bit teary when we think about how many months it’ll be before we see him again, but such is our life, and his. We are on our way home now, back to Toledo through the ice and snow, and thence back to Scotland and our life there, thankful for miracles, great and small.

Two Papers with Peter Rober

Entry for 9 August 2008:

In 2004, when I arrived in Belgium to start my two years of regular 2-week stints as visiting professor at the University of Leuven, I was introduced to Peter Rober, a family therapist well-known there for his entertaining and illuminating books and magazine articles. Peter was trying to finish his doctoral dissertation, and asked to meet with me for a research consultation. He had several scientific articles published already, which he could incorporate into the dissertation, and had just completed data collection on a study using Interpersonal Process Recall (IPR) to study therapists’ moment-to-moment experiences during therapy sessions. Although it was a therapy analogue study using a standard client presenting one of several role-played problems, this was really an extension of Rennie’s ground-breaking study of client in-session experiences. In other words, Peter was trying to do for therapist in-session experiences what Rennie had done for client in-session experiences: establish its basic geography, forms and varieties.

Over a meal in a traditional Belgian restaurant, I laid out for him how he could analyse his data and organize the remaining pieces of his dissertation. As a result, I got asked to be co-supervisor on his dissertation, and ended up collaborating with him on several articles. The second and third of these articles, based on the IPR studied we first talked about almost 4 years ago, have now been published, in Psychotherapy Research and Journal of Marital and Family Therapy, respectively.

The two articles lay out the Grounded Theory Analysis of therapy in-session experiences. The first of these (Rober et al., 2008a), presents the basic category structure, while the second (Robert et al., 2008b) illustrates some key points and further elaborates the clinical implications. It’s nice to see these paper in print, both because they are interesting research interestingly told, but also because they remind me of the fun times Peter and I had working on this research. What’s the point of doing research if it can’t be fun?

Reference: Rober, P., Elliott, R., Buysse, A., Loots, G., & De Corte, K. (2008a). What's on the therapist's mind? A grounded theory analysis of family therapist reflections during individual therapy sessions. Psychotherapy Research, 18, 48-57.

Abstract. The authors used a videotape-assisted recall procedure to study the content of family therapists’ inner conversations during individual sessions with a standardized client. Grounded theory was used to analyze therapists’ reflections, resulting in a taxonomy of 282 different codes in a hierarchical tree structure of six levels, organized into four general domains: attending to client process; processing the client’s story; focusing on therapists’ own experience; and managing the therapeutic process. In addition to providing a descriptive model of therapists’ inner conversation, this research led to an appreciation of the wealth of therapists’ inner conversation. In particular, the authors found that therapists work hard to create an intersubjective space within which to talk by trying to be in tune with their clients and by using clients as a guide.

Reference: Rober, P., Elliott, R., Buysse, A., Loots, G., & De Corte, K. (2008b). Positioning in the therapist's inner conversation: A dialogical model based on a grounded theory analysis of therapist reflections. Journal of Marital and Family Therapy, 34, 406-421.

Abstract. In recent years, a dialogical perspective has emerged in the family therapy field in which the therapist’s inner conversation is conceptualized as a dialogical self. In this study, we analyze the data of a grounded theory study of therapist reflections and we portray the therapist’s self as a dynamic multiplicity of inner positions embodied as voices, having dialogical relationships in terms of questions and answers or agreement and disagreement. We propose a descriptive model of the therapist’s inner conversation with four positions. In this model, each of the four positions represents a concern of the therapist: attending to the client’s pro- cess, processing the client’s story, focusing on the therapist’s own experience, and managing the therapeutic process. Detailed analyses of vignettes of therapist reflections illustrate the model, and implications of this model for training and supervision are considered.

On Pre-Post Effect Size Statistics

Entry for 27 July 2008:

Jess Owen, of Gannon University, has written to the SPR list server with an interesting question:

I was wondering if anyone had a good reference or just general thoughts for adjusting the effect size for single group pre-post study?

Currently, I have found a consistent theme in the literature to use the pre-SD in the equation. However, even with the pre-SD, I am finding some pretty large effect sizes (e.g., > 2). I would like to think that the intervention made a big difference, but I am better sure that this is inflated given the use of only an experimental group.

This question has statistical, design, and substantive implications.

First, in narrow statistical terms, it depends on what kind of significance test was used: If the client pre-post scores aren’t paired, then an independent samples t-test is used to detect whether the difference is statistically significant, and one divides the difference of pre- and post test by the pooled standard deviation (the geometric mean of pre and post standard deviations). This is the situation that Jess Owen is referring to. However, where pre-post client scores can be paired, a more powerful statistical test is available: the dependent t-test, which takes advantage of the pre-post (or test-retest) correlation to reduce error – a long as the pre-post correlation is .5 or higher. In meta-analysis, the pre-post correlation is generally not available, so one has to resort to rules of thumb estimation procedures (e.g., Smith, Glass & Miller, 1980; if it’s a standardized inventory measure given at a 4-month interval, assume r = .5). I personally don’t like having to use these estimation procedures, which is one reason why I don’t use effect sizes based on dependent t-tests.

Second, methodologically, it depends on how you are thinking of the pre-test. For example, I like to conceptualize the pre-test as representing the population of clients not in therapy, while the post-test represents the population of clients who have had therapy. This is the logic of talking about therapy from the point of view helping client moving from one population to another, e.g., the average client moves from the 50th to the 85th percentile of the untreated population, which is another way of saying that they improved by about one standard deviation unit. In this way, also, it makes sense to use the straightforward standardized different metric described above.

Third, substantively, it appears that uncontrolled pre-post effect sizes do tend to run larger than controlled effects between the post test scores of treated and untreated clients. Lipsey and Wilson (1993) reported this in their meta-meta-analysis. However, it’s never been clear to me how much their results reflect the use of the ESs based on dependent t-tests, or whether pre-post effects are just bigger than controlled post-only effects. Fortunately, it turns out that I can use the person-centred/experiential (PCE) therapy meta-analysis results to shed some light on this question: In this data set, clients seen in PCE therapy change about 1.0 sd (=a very large effect), while control participants change about .2 sd (a small effect); as a result, the controlled standardized gain statistic (i.e., the difference between treated and untreated participants) is about .8 sd (a large effect). In other words, the pre-post ES is a wee bit bigger than the controlled ES, and this is important to be aware of. This is of course why no-treatment control designs are used in first place, but the data show that in general such controls don’t do much except make our studies look more scientific. However, there are always exceptions; for example, some types of clients probably improve on their own more than .2 sd, while untreated distressed couples may get worse!

As a result of all three of these considerations, I prefer to use a simple standardized difference as a basic effect size for therapy outcome research: It’s more conservative (generally) than an effect size based on the dependent t-test; it’s easier to think about in population terms; and it’s closer rather than further away from a controlled ES. A final note: Psychotherapy is a wonderful thing, and perfectly capable of producing extremely large effects, including one on the order of 2 or 3 sd or even larger!

Lipsey, M.W., & Wilson, D.B. (1993). The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis. American Psychologist, 48, 1181-1209.

Smith, M.L., Glass, G.V., & Miller, T.I. (1980). The benefits of psychotherapy. Baltimore: The Johns Hopkins University Press.

Article: Research on Client Experiences of Therapy

Entry to 7 May 2008:

From time to time I end up writing an introduction for a special section of Psychotherapy Research. Because of my generally crazy life, these tend to get written at the last minute, under time pressure. And yet, these short pieces are among my favourite articles, because they offer an opportunity to take stock of an area of research. Meerkat-like, I get to stand up on the small hill made by the accumulation of articles on the topic at hand and look to the horizon. Like the sentinel meerkat, I’m not very big and the hill isn’t that high, so I can’t see very far, but it’s farther than the other meerkats can see, and sometimes I have been able to tell what’s coming, which the other meerkats have occasionally found useful.

A year ago, Clara Hill, long-time fellow therapy process researcher and current editor of Psychotherapy Research, asked me to do one of these introduction pieces for a special section of PR on Client Experiences of Psychotherapy. I could hardly say no, because I have spent a substantial part of my research career championing research on this topic, and also because I had published (with Elisabeth James) a qualitative meta-synthesis on client experiences in 1989. In the end, the special section turned out to have six papers, mostly qualitative studies. This provided an opportunity to characterize three current genres of therapy process research:

• Interpersonal Process Recall studies of important therapy events.
• Mental health service evaluation research using qualitative interviews to learn about what clients find helpful or hindering.
• Quantitative survey research evaluating predictors of important therapy processes.

Next, I revived my 1991 Five Dimensional Model of therapy process, the conceptual framework that underlies the Comprehensive Process Analysis method I developed in the 1980’s. This organizes therapy process along five essential dimensions:

• Perspective of observation (client, therapist, observer)
• Person being observed (client, therapist, relationship)
• Unit of process (e.g., speaking turn, session, whole therapy relationship)
• Temporal phase (context, process, consequences)
• Aspect of process (content, action, style, quality)

I used this framework to characterize the six studies, point to commonly studied and overlooked therapy process elements.

Finally, I summarized what could be learned from the six studies, concluding by underscoring the importance of the two Interpersonal Process Recall studies (from the very productive research group of Heidi Levitt at the University of Memphis). It seems to me that these studies point to the importance of studying client agency in the face of therapeutic difficulties (e.g., discovering that you and your therapist don’t see eye to eye on something). I would like to believe that these studies are pointing to an emerging research front that warrants further investigation “to identify a taxonomy of client process difficulties, along with descriptions of common client coping strategies, and lists of therapist responses that can help or hinder clients in resolving these difficulties” p. 242). Such a line of research would complement research on therapist-defined tasks, as developed by Greenberg and Rice, but would focus instead on client-defined tasks.

Reference: Elliott, R. (2008). Research on Client Experiences of Therapy: Introduction to the Special Section. Psychotherapy Research, 18, 239-242.

It turns out that PR is no longer publishing abstracts for introductions to special sections, but the following is the abstract I wrote for this paper:

Abstract: I introduce this special section of research on client experiences of therapy by looking at the six studies reported here from three different angles. First, I summarize each study and characterize it in terms of the current research genres represented. Next, I analyze the studies in terms of the Five Dimensional Model of therapy process (Elliott, 1991). Finally, I briefly summarize what we have learned about the three main questions addressed by these studies: What clients find helpful or hindering in therapy? How do clients see themselves as having changed over the course of therapy?, and, How do clients deal with difficulties in the therapeutic process?

Article: A Linguistic Phenomenology of Ways of Knowing

Entry for 4 May 2008:

In 1971, Ted Sarbin, my mentor at the University of California, Santa Cruz, handed me a copy of a paper he had just had published [Sarbin, T.R., & Adler, N. (1971). Self-reconstitution processes: A preliminary report. The Psychoanalytic Review, 57, 599-616.] This paper, with its wide-ranging analysis of the factors shared by diverse systems for bringing about drastic personal change, electrified me. The result was my undergraduate senior thesis on metaphors for death and birth and their implications for radical person change. In my thesis, I developed a method for using word etymology and metaphor analysis to analyze psychological constructs. Over the ensuing decades, I used this research method sporadically, to analyze concepts such as “psychological dysfunction”, “empathy,” and most recently “insight” [Elliott, R. (2006). Decoding Insight Talk: Discourse Analyses of Insight in Ordinary Language and in Psychotherapy. In L G. Castonguay & C.E. Hill (Eds), Insight in Psychotherapy (167-185). Washington, DC: APA.]

Several years ago I was asked to write a paper on epistemological issues in psychotherapy research for the Journal of Psychotherapy Integration. I have a long-standing interest in epistemology and philosophy of science, but am not by any means trained or deeply read in these fields, so I approached this assignment with fear and trembling. I ended up dealing with the situation by going back to basics: analyzing verbs of knowing using metaphor analysis, following Lakoff and Johnson, and returning to my old strategy of root metaphor analysis.

After a long delay, this paper has finally been published in JPI (the journal of the Society for Psychotherapy Integration) along with two accompanying papers, one an introduction and the other a commentary on my paper. I've never been given such treatment before and find it all a bit intimidating, but it is fun to see the final product and to view this particular piece of work through others' lenses, in this case three fairly heavy hitters in philosophical psychology: Robert Woolfolk, Frank Richardson, and Jack Anchin. Given that this paper is probably the most unusual paper I've ever published, it's a relief that they didn't just tear it to shreds.

In the title of the paper I refer to “linguistic phenomenology”, a term that refers to the use of language -- and particularly analysis of the metaphors used to construct words -- as a method for illuminating important human experiences. My use of this method was developed independently of Lakoff and Johnson’s later work on metaphor, most famously in Metaphors we live by (1980). However, my resumption of this method has been inspired by their work, especially their 1999 book [Lakoff, G., & Johnson, M. (1999). Philosophy in the flesh: The embodied mind and its challenge to western thought. New York: Basic Books.]

Reference: Elliott, R. (2008). A Linguistic Phenomenology of ways of knowing and its implications for psychotherapy research and psychotherapy integration. Journal of Psychotherapy Integration, 18, 40-65.

Abstract: In this article, I use the linguistic methods of Lakoff and Johnson (1999) to deconstruct the underlying conceptual structure and metaphors for three key verbs of Knowing, in order to answer three central methodological questions: First, is Description possible? Yes, in the sense of writing things down carefully but fallibly, while trying to avoid the danger of confusing permanence with truth. Second, is Interpretation inevitable? Yes, in the sense of Translating between an audience and a text, but not in the sense Making Something Easier to See or Constructing a Model (these are desirable but not inevitable). Third, are Explaining and Understanding fundamentally different ways of Knowing? Yes, they differ in structure (mediated vs. direct knowledge), direction (toward general simplicity vs. unique complexity), and effect (constructing a conceptual model vs. creating a relationship). Consistent with the goals of the psychotherapy integration movement, I conclude that Describing, Explaining, and Understanding are each essential to psychotherapy and psychotherapy research.


Ted Sarbin, whose 1971 paper set me on the path to this paper, died in August 2005, at the age of 94. It’s not common to dedicate scientific papers to people, and this paper carries no explicit inscription. Nevertheless, let it be known here that in fact this paper on the metaphors implicit in verbs of knowing is dedicated to his memory.

New Publication: Dekeyser, Prouty & Elliott (2008) Review of Research on Pre-therapy

Entry for 8 March 2008:

Just out in the latest issue of Person-Centered and Experiential Psychotherapies is a review paper I co-authored on research on Pre-Therapy. This article began its life several years ago in a submission to PCEP by Gary Prouty, but subsequently passed through many transformations and revisions to reach its present form, eventually acquiring my doctoral student Mathias Dekeyser of KU Leuven as first author (it’s a chunk of his dissertation) and me as third author for my role of supervising, consulting, effect-size calculation and helping with the writing.

The Pre-therapy research literature is actually pretty sparse, there turned out to be enough to review. Surprisingly, word of the paper has spread through the Pre-therapy Network and even came up in January when we met Mick, Nancy, Sally and I met in London with Tony Roth, Steve Pilling: Catherine Clarke, the service user/carer representative on the PCE Expert Reference Group had caught wind of the impending publication and used its existence to argue for inclusion of Pre-therapy in the core competency work.

Reference: Dekeyser, M., Prouty, G., & Elliott, R. (2008). Pre-Therapy process and outcome: A review of research instruments and findings. Person-Centered and Experiential Psychotherapies, 7, 37-55.

Abstract: Pre-Therapy employs contact reflections to stimulate contact behavior in persons experiencing psychosis. We offer a review of Pre-Therapy research instruments and findings. The Pre-Therapy Rating Scale (PTRS; Prouty, 1994) and the Evaluation Criterion for the Pre-Therapy Interview (ECPI; Dinacci, 1997) have been the two most frequently used instruments for the assessment of contact behavior. PTRS scores seem more reliable than ECPI scores, but all manuals need revision. Particular attention is needed for the rating of non-verbal behavior. A preliminary evaluation of the structure of the PTRS indicates that it is two-dimensional rather than three-dimensional. The PTRS and the ECPI can be regarded as measures of communicative contact but also as measures of the meaningfulness of communication. Preliminary outcome studies suggest that pre-post and comparative effect sizes of Pre-Therapy are large for communicative contact, but the number of participants in these studies is generally low, as is the number of systematic case studies.

Another New Publication: Elliott & Freire (2007)

Entry for Oct 29 2007:

Gene Gendlin founded Psychotherapy: Theory, Research, Practice & Training, the house journal of the Division of Psychotherapy of the American Psychological Association. Since then it has had its ups and down, but recently it has been flourishing under the editorship of Charlie Gelso, a colleague of Clara Hill's at the University of Maryland. Last year, Charlie asked me to write a short piece for a special section of the journal marking the 50th anniversary of the publication of Carl Rogers’ famous paper on the facilitative conditions. I wrote back to Charlie asking if there were any classical person-centred folks writing commentary pieces. The answer was no. Because this offended my sense of fairness, I invited my classical colleague Beth Freire to co-author the piece with me, with each of us presenting our own view of Rogers (1957) in a kind of dialogue. Charlie got a “twofer”, and Beth and I got the experience of collaborating on the paper, which turned out to be a very nice experience. As with Elliott & Greenberg (2007), the hardest part turned out to be working within the page limit, but we managed, and were very pleased with the result, cited below with the abstract.

Elliott, R., & Freire, E. (2007). Classical Person-Centered and Experiential Perspectives on Rogers (1957). Psychotherapy, 3, 285-288.

Abstract. Rogers (1957) foreshadows the later development of the person-centered approach in North America and elsewhere. In this paper, we present contrasting perspectives on the legacy of this key paper: First, from the perspective of classical person-centered therapy, Freire describes the context for this key paper within the wider frame of Rogers’ body of work and emphasizes its continuing importance and relevance. Second, Elliott offers a personal history from the point of view of a psychotherapy researcher and process-experiential therapist. These two perspectives represent two major and distinct views of Rogers’ legacy from within his direct intellectual and therapeutic descendents.

New Publication: Elliott & Greenberg (2007)

Entry for 29 October 2007:

A couple of years ago, Al Mahrer approached me about contributing an article on my and Les’ approach to therapy for a special section on Experiential Psychotherapy for the American Journal of Psychotherapy. In due course, the deadline approached and the article was rewritten, submitted, revised etc. Last week I got my copy of the issue with this article in it.

In this article, I tried to communicate the basic ideas of Process-Experiential/ Emotion-Focused Therapy (PE-EFT) as clearly and simply as possible, which at times felt a bit like writing haiku, trying to communicate richness and depth in simplicity. I’m not sure how well we succeeded but I think it was worth a try, anyway. And besides, I had always thought it would be cool to publish something in this particular journal, a classic, old-time psychotherapy journal published by the American Academy of Psychotherapists that I have been reading tables of contents, and more recently abstracts, from for many years. It was a fun project, and I hope some people find it useful. Interestingly, in an introductory piece to the special section, Al Mahrer now regrets the use of the term “experiential psychotherapy” and wonders what all the therapies grouped under its umbrella really have in common… At any rate, here is the citation and an abstract for the paper:

Elliott, R., & L.S. Greenberg. (2007). The Essence of Process-Experiential /Emotion-Focused Therapy. American Journal of Psychotherapy, 61, 241-254.

Abstract. Process-Experiential/Emotion-Focused Therapy (PE-EFT; Elliott et al., 2004; Greenberg et al., 1993) is an empirically-supported, neo-humanistic approach that integrates and updates Person-centered, Gestalt and existential therapies. In this article we first present what we see as PE-EFT’s five essential features, namely neo-humanistic values, process-experiential emotion theory, person-centered but process-guiding relational stance, therapist exploratory response style, and marker-guided task strategy. Next, we summarize six treatment principles that guide therapists in carrying out this therapy: achieving empathic attunement, fostering an empathic, caring therapeutic bond, facilitating task collaboration, helping the client process experience appropriately to the task, supporting completion of key client tasks, and fostering client development and empowerment. In general PE-EFT is an approach that seeks to help clients transform contradictions and impasses into wellsprings for growth.

Rogers and Sarbin

Entry for 3 August 2007:

Barry Farber (an old SPR friend who teaches at Columbia University) and I are writing an chapter on Carl Rogers for a book on important psychotherapy researchers. To help with this, I managed to get a hold of an advance copy of Howard Kirschenbaum’s forthcoming The Life and Work of Carl Rogers. I’m supposed to be skimming it for relevant bits on his career as a psychotherapy researcher, but it is a fascinating read, and I keep getting distracted by interesting bits.

This morning I ran across a curious synchronist bit in the chapter on Rogers’ Ohio years. In 1940, a junior faculty member at the University of Minnesota invited Rogers to come give a lecture on counselling and psychotherapy. This turned out to an historically important lecture, because it was here that Rogers began to lay out his critique of directive approaches to counselling and to describe a more growth-oriented alternative. In order to support his point, he quoted a passage from a recent article, in which the author described a not-very-successful attempt to get an undergraduate student to change his major.

What really caught me eye, however, was the identity of both the junior faculty member and the counselor in the quoted passage: It was Ted Sarbin, my undergraduate mentor from the University of California at Santa Cruz!

Kirschenbaum notes that Rogers reported having been mortified to learn that the counselor in the passage was in the audience and was fact Ted Sarbin. However, Kirschenbaum also interviewed Sarbin , who said that he was impressed by Rogers' tact in mentioning him by name! My sense of Ted Sarbin is that he would not have taken it personally and would have been amused rather than offended by Rogers’ using him as an example of bad practice. In my experience, that was the kind of person he was. When I took his course, “The Social Psychology of Deviant Conduct” at UC Santa Cruz in 1971 or so, he told us many interesting and unusual stories of clients he saw, not all of whom had good outcomes.

I am fascinated by this conjunction between two key important figures in my development as a psychologist. It’s ironic that I am writing about Carl Rogers, whom I only met once (casually, at APA in 1980), whereas I knew Ted Sarbin fairly well. But it made me think again about Ted Sarbin and the role he played supporting my intellectual development: His sparking my interest in metaphor; his critique of traditional mental health concepts and practices, different but parallel to Rogers’; the strength of his loyalty to his students, which has come to mean more to me over the years as I have appreciated how unusual it is; and his intellectually adventurous spirit and courage.

Ted Sarbin died in 2005, at the age of 94. Three years before he died, he contacted me to invite me to my first “Sarbin dinner.” This dinner was a 40-year tradition that he held for his students and friends at APA, during which he gave out the Role Theorist of the Year Award, the remit for which had broadened over the years to include contributions to narrative and critical psychology as well.

I had not seen him in years, but there was something he wanted to tell me and the others there: That for years he had felt badly about not having properly credited my thesis research in a book chapter he had written a couple of years after I graduated. For my part, at the time I had been a bit bothered by the incident, which I soon came to understand as one of those stupid, embarrassing things that sometimes happens in producing a paper; but I had long since moved on. Nevertheless, I was immensely moved and touched by his public confession. After that, I attended two more Sarbin dinners at APA. In the summer of 2005, he contacted me twice to make sure I was going to be there, and then at that years’ APA conference in Washington, DC, knowing that he was dying of cancer, he gave out two of his awards, the last of which he gave to me. He died ten days later. The award plaque he gave me is one of my most treasured mementos.

All of this came back to me this morning as I read about the long ago encounter of these two key figures in 20th century American psychology, who are also two of my own most important influences and role models. Ted Sarbin never became a person-centred therapist – he followed no school, although he is the founder of narrative psychology - but he and Carl Rogers shared much in common, and I think I can say that he always supported my growth tendency and inspired me to follow it, while treating me with acceptance, empathy and integrity. It is one of my main goals to try to live up to his example.